POS0801 VISUAL INVOLVEMENT AND PERMANENT VISUAL LOSS IN GIANT CELL ARTERITIS: PREDICTIVE FACTORS
Authors: L. Sanchez-Bilbao, J. Loricera, C. Moriano, S. Castañeda, I. Ferraz-Amaro, J. Narváez, V. Aldasoro, O. Maiz, R. Melero, I. Villa-Blanco, P. Vela-Casasempere, S. Romero-Yuste, J. L. Callejas-Rubio, E. De Miguel, E. Galíndez-Agirregoikoa, F. Sivera, C. Fernández-López, C. Galisteo, J. Sanchez-Martin, M. Calderón-Goercke, J. L. Hernández, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2022)

Background Visual involvement is the most feared complication of Giant Cell Arteritis (GCA) (1-5 ). Permanent visual loss (PVL) may be preceded by transient visual loss. Once blindness is established, the prognosis is poor. Most of the series of predictive factors of visual involvement in GCA are old and with a small number of patients. Objectives To assess the predictive factors of visual involvement and PVL in GCA. Methods Multicenter observational study of 471 patients with GCA. The diagnosis of GCA was performed between 2016 and 2021 according to: a ) ACR criteria, and/or b ) temporal artery biopsy, and/or c ) imaging techniques. From the 471 patients, we selected patients who developed a ) visual involvement at any time during GCA and b ) PVL. PVL was defined as partial or complete visual loss of &gt;24 hours. Predictive factors were identified by multivariate analysis. Results Visual involvement was observed in 122 cases and PVL in 60 (Table 1). The ischemic and systemic manifestations set of variables associated with visual involvement were headache, and jaw claudication, whereas large-vessel involvement was a protective variable (Figure 1). The area under the curve (AUC) for the model was 0.72 (95%CI 0.67-0.77; p&lt;0.0001). Figure 1. Forest plot of multivariate analysis. Table 1. Main features of the patients Overall (n= 471) GCA without visual involvement (n=349) GCA with visual involvement (n= 122) GCA with PVL (n=60) P visual vs non visual involvement P PVL vs non visual involvement Age at diagnosis of GCA (mean±SD) 72±9 71±9 75±8 75±9 0.001 0.001 Female/Male (% of female) 342/129 (73) 265/84 (76) 77/45 (63) 41/19 (68) 0.006 0.21 Positive TAB, n (%) 201 (43) 146 (42) 55 (45) 33 (55) 0.53 0.34 Cardiovascular risk factors High blood pressure, n (%) 272 (58) 189 (54) 83 (68) 40 (67) 0.013 0.058 Dyslipidemia, n (%) 241 (51) 175 (50) 66 (54) 32 (53) 0.61 0.63 Diabetes, n (%) 81 (17) 50 (14) 31 (25) 16 (27) 0.007 0.016 Previous or current smoking history, n (%) 47 (10) 31 (9) 16 (13) 8 (13) 0.21 0.27 CHADS2 score, median [IQR] 1 [1-2] 1 [0-2] 2 [1-2] 2 [1-2] 0.001 0.004 Ischemic manifestations Headache, n (%) 259 (55) 167 (48) 92 (75) 42 (70) 0.000 0.002 Jaw claudication, n (%) 112 (24) 63 (18) 49 (40) 26 (43) 0.000 0.000 Systemic manifestations Fever, n (%) 57 (12) 47 (13) 10 (8) 4 (7) 0.12 0.20 Constitutional syndrome, n (%) 175 (37) 132 (38) 43 (35) 20 (33) 0.55 0.47 PmR, n (%) 284 (60) 218 (62) 66 (54) 29 (48) 0.094 0.022 Large-vessel involvement, n (%) 254 (54) 211 (60) 43 (35) 20 (33) 0.000 0.000 ESR, mm/1 st hour, median [IQR] 32 [12-57] 30 [11-54] 34 [15-67] 42 [12-67] 0.22 0.28 CRP (mg/dL), median [IQR] 1.5 [0.5-3.4] 1.4 [0.5-3.0] 1.5 [0.4-4.7] 1.5 [0.4-3.6] 0.042 0.30 In the same line, the set of variables associated with PVL were headache, and jaw claudication. By contrast, polymyalgia rheumatica (PmR), and large-vessel involvement were protective factors (Figure 1). The AUC for this model was 0.77 (95%CI 0.71-0.83; p&lt;0.0001). Conclusion Headache, and jaw claudication seem to be associated with visual involvement in GCA, while large vessel involvement seems to be a protective factor. PmR also appears to be a protective factor for the development of PVL. References [1]Calderón-Goercke M, et al. Semin Arthritis Rheum. 2019; 49: 126-135. PMID: 30655091 [2]Baalbaki H, et al. Clin Rheumatol. 2021; 40: 3207-3217. PMID: 33580374 [3]González-Gay MA, et al. Arthritis Rheum. 1998; 41: 1497-1504. PMID: 9704651 [4]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019; 48: 720-727. PMID: 29903537 [5]Martínez-Rodríguez I, et al. Semin Arthritis Rheum. 2018; 47: 530-537. PMID: 28967430 Acknowledgements Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group. Disclosure of Interests Lara Sanchez-Bilbao: None declared, Javier Loricera Speakers bureau: Roche, Novartis, UCB Pharma, Celgene, and Grünenthal, Clara Moriano: None declared, Santos Castañeda Speakers bureau: UAM-Roche, EPID- Future chair, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain., Iván Ferraz-Amaro: None declared, J. Narváez: None declared, Vicente Aldasoro: None declared, Olga Maiz: None declared, Rafael Melero: None declared, Ignacio Villa-Blanco: None declared, Paloma Vela-Casasempere: None declared, Susana Romero-Yuste: None declared, Jose Luis Callejas-Rubio: None declared, Eugenio de Miguel: None declared, E. Galíndez-Agirregoikoa: None declared, Francisca Sivera: None declared, Carlos Fernández-López: None declared, Carles Galisteo: None declared, Julio Sanchez-Martin: None declared, Monica Calderón-Goercke: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, and MSD., Grant/research support from: AbbVie, MSD, Jansen, and Roche,, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Lilly, Janssen, and MSD., Grant/research support from: Abbvie, MSD, and Roche